Clinical Cardiology最新文献

Aims

We employed a robust genetic approach to provide a better understanding of whether Gastroesophageal reflux disease (GERD) contributes to coronary artery disease (CAD) risk from a genetic perspective.

Methods

Multivariable Mendelian Randomization (MVMR) was applied to explore causal links between GERD and CAD using genetic instruments derived from genome-wide association studies (GWAS). The MVMR models were adjusted for key metabolic confounders, including low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), systolic blood pressure (SBP), and glycated hemoglobin (HbA1c). Genetic correlations were estimated using linkage disequilibrium score regression. Cross-trait meta-analyses, Heritability Estimation from Summary Statistics (ρ-HESS) and colocalization analyses were performed to identify pleiotropic genes and shared genetic loci, elucidating the genetic relationship between GERD and CAD.

Results

Genetically predicted GERD was found to be causally linked with CAD (rg = 0.38, P = 2.37E-52), independent of metabolic risk factors, including LDL-C, BMI, SBP, and HbA1c (odds ratio: 1.24, 95% CI: 1.02–1.52, p < 0.05). Cross-trait meta-analyses identified eight novel pleiotropic single nucleotide polymorphisms, four of which were independent of metabolic confounders, including rs11764337 in MAD1L1, rs2240326 in RBM5, rs9615905 in FAM19A5, and rs9837341 in BSN. ρ-HESS and colocalization analysis further revealed shared genetic loci for GERD and CAD, specifically rs4643373 in IGF2BP1 (located in chr17: 45876022-47517400 and posterior probability for H4 > 0.75).

Conclusions

GERD is identified as an independent risk factor for CAD. The discovery of shared genetic loci provides novel insights into the genetic mechanisms underlying GERD and CAD, with IGF2BP1 emerging as a potential therapeutic target for intervention.

Background

Coronary artery disease (CAD) is a common comorbidity in patients with atrial fibrillation (AF), and optimal antithrombotic medication improves clinical outcomes in this high-risk population. The aim of our study was to describe antithrombotic drug regimens in different patient cohorts.

Methods

We investigated data from the prospective Helios Heart registry (H2) and the Heart Center Leipzig routine clinical database (HZL). We included inpatient cases with AF and CAD (hospitalized from March 2021 to July 2024 [H2] or January 2017 to December 2021 [HZL]), who underwent percutaneous coronary intervention (PCI) within the last 12 months. Information on clinical characteristics, coronary interventions, and medication prescribed was obtained from electronic case report forms and/or administrative data based on ICD-10, OPS, and ATC codes.

Results

We included 3481 (HZL), and 205 (H2) index cases with comparable baseline characteristics. Overall, 92.5% (HZL) and 87.6% (H2) of patients were on any anticoagulation, and 93.0% (HZL) and 80.2% (H2) were prescribed ≥ 1 antiplatelet agent. There were relevant differences in antithrombotic therapy when stratifying for PCI timing. Factors associated with higher (older age) or lower (comorbidity burden, antiplatelet treatment, prior left atrial appendage occlusion) prescription rates of OAC were identified. OAC therapy without adjunctive antiplatelet therapy was associated with an increased rate of rehospitalization for major adverse cardiovascular events at 12 months (HZL).

Conclusion

We presented current data on antithrombotic drug utilization in patients with AF and CAD and found comorbidity burden, concomitant antiplatelet treatment and other factors to be associated with lower anticoagulant prescription rates.

Background

Correlations between platelet-to-lymphocyte ratio (PLR) and prognosis in patients with acute myocardial infarction (AMI) are reported in more studies, though there is no evidence-based data.

Methods

Databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched from their inception to April 19, 2024, to retrieve articles discussing associations between PLR and clinical outcomes in AMI patients. The primary outcomes, comprising mortality and major adverse cardiovascular events (MACE), were assessed with odds ratios (OR) and their 95% confidence intervals (CI). Sensitivity analyses and subgroup analyses were utilized to probe the results' robustness and potential heterogeneity sources. Analysis was carried out utilizing the software of Review Manager 5.4 & STATA 15.0.

Results

This article selected 18 cohort studies, covering 16,545 AMI patients. The meta-analysis found that elevated PLR was significantly linked with mortality in AMI patients (OR = 1.06; 95% CI: 1.04–1.08, p < 0.00001). Additionally, PLR was highly linked with MACE risks in AMI patients (OR = 1.495; 95% CI: 1.24–1.80, p < 0.0001). Further subgroup analyses discovered a significant correlation between PLR and mortality in prospective studies (OR = 1.07; 95% CI: 1.05–1.09), studies with a sample size ≥ 500 (OR = 1.06; 95% CI: 1.04–1.08), patients under 70 years of age (OR = 1.07; 95% CI: 1.05–1.09), studies from European regions (OR = 1.08; 95% CI: 1.06–1.10), patients with ST-elevation myocardial infarction (OR = 1.09; 95% CI: 1.07–1.11), and those with a PLR cutoff value < 140 (OR = 1.07; 95% CI: 1.05–1.09) (p < 0.05). For MACE, similar subgroup analyses also proved an obvious correlation between PLR and MACE in the aforementioned subgroups (p < 0.05).

Conclusion

PLR values are linked with mortality and MACE in AMI patients. PLR serves as an effective prognostic biomarker for AMI patients, providing precious opinions for sensible therapeutic decisions in AMI treatments.

Introduction

The leadless pacemakers are implanted routinely under fluoroscopic image, yet the pacing sites and corresponding paced electrocardiography (ECG) remain unclear. This study was to determine the computed tomography (CT)-verified location of the leadless Micra pacemakers (Micra) and ECG characteristics.

Methods

Twenty consecutive patients who met the pacemaker indications for bradycardia and underwent fluoroscopy assisted Micra implantation were enrolled. All subjects underwent a postoperative CT scan to determine the precise location of the Micra pacing tip. Paced 12-lead ECG characteristics were analysed and correlated with the Micra tip location.

Results

In the nine partitions of fluoroscopic RAO images, 14 (70%) of 20 patients had the Micra tip in zone 5, 5 (25%) in zone 6 and 1 in zone 2. Reconstructed CT 3-D cardiac images found Micra tips mostly clustered near the anterior insertion between the RV septum and free wall with 12 cases at the insertion-septal side and 8 at the free-wall side. ECG morphological analysis found that the peak deflection index in ECG lead V1 was 0.409 ± 0.058 for Micra tips at the insertion-septal side and 0.527 ± 0.062 in the free-wall side (p < 0.001 between two sides) and R wave amplitude in lead V6 appeared larger for Micra tips in the free-wall group compared to Micra tips in the insertion-septal group, while there was no difference in QRS duration between two sides.

Conclusion

In routine Micra implantation, the pacing sites were often located in the anterior insertion region.

Background

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce cardiovascular mortality and heart failure (HF)-related hospitalizations in HF patients. However, the mechanisms underlying these benefits remain unclear, and it is uncertain whether empagliflozin and dapagliflozin have differential effects on cardiac structure and function.

Aim

This study aims to compare the effects of these two SGLT2is on left ventricular echocardiographic parameters in HF patients over 1 year.

Methods

This retrospective study included 558 consecutive HF patients newly prescribed either dapagliflozin or empagliflozin. Key echocardiographic parameters, such as peak E-wave velocity, E/e' ratio, left atrial volume index (LAVI), LV end-diastolic and end-systolic volumes (LV-EDVI, LV-ESVI), LV mass index (LV-MI), relative wall thickness (RWT), LV sphericity index (LV-SI), and ejection fraction (LVEF), were measured at baseline and after 1 year.

Results

At 1-year, significant reductions were observed only in the empagliflozin group for peak E-wave velocity (mean difference = −12.76 cm/s, 95% CI: −16.26 to −9.27, p < 0.001), E/e' ratio (mean difference = −3.04, 95% CI: −4.17 to −1.91, p < 0.001), and LV sphericity index (LV-SI; mean difference = −0.01, 95% CI: −0.02 to −0.0005, p = 0.040). Both SGLT2is significantly improved E-wave deceleration time, LAVI, LV-EDVI, LV-ESVI, LV-MI, and LVEF. Neither medication produced significant changes in RWT, and no significant differences were noted between groups regarding HF hospitalizations or all-cause mortality.

Conclusion

Empagliflozin demonstrated more pronounced effects on LV remodeling markers, including peak E-wave velocity, E/e' ratio, and LV-SI, compared to dapagliflozin. These findings suggest potential efficacy differences between SGLT2is, highlighting the need for future randomized comparative studies.

Aim

To evaluate sex-based differences in the prescription of the combination of evidence-based medicine (cEBM) at discharge after an acute ST-elevation myocardial infarction (STEMI). Secondly, we analysed risk factors for the absence of cEBM after discharge, and examined sex differences in adverse events.

Methods

This retrospective cohort study compared women to men who were admitted with an acute STEMI at Haga Teaching Hospital between January 2017 and June 2023. The primary outcome was cEBM, defined as an active prescription of the combination of acetylsalicylic acid, P2Y₁₂-inhibitor, ACEi/ARB, beta-blocker, and statin/ezetimibe on the day after discharge.

Results

Among 1467 patients (27% women), women were older than men (74 years vs. 65 years, p < 0.001). cEBM was less often prescribed to women than men (66.0% vs. 72.8%, p = 0.013), primarily due to ACEi/ARB (82.1% vs. 87.7%, p = 0.007) and statins (90.2% vs. 95.2%, p = 0.001). In a multivariable logistic regression analysis, female sex was not associated with the absence of cEBM (Odds Ratio (OR) = 1.01, 95% confidence interval [95% CI]: 0.73–1.39). Other confounders such as increasing age, decreasing haemoglobin, and oral anticoagulants were correlated with the absence of cEBM.

Conclusions

A smaller proportion of women were prescribed cEBM post-STEMI compared to men. However, this difference disappeared when controlled for other confounders. Also, women remained to have a higher chance for a stroke or death at 6 months post-discharge. These findings highlight the need for further research into sex disparities and their underlying confounders in the field of evidence-based medicine after an acute STEMI.

Background

Preeclampsia (PE), a leading cause of maternal morbidity, lacks reliable early biomarkers. This study evaluates acoustic cardiography (ACG) for noninvasive left ventricular ejection time (LVET) monitoring and its predictive value in PE.

Methods

In an observational case-control study, 59 pregnant women (28 controls, 31 PE cases) underwent synchronized ECG-phonocardiogram (PCG) monitoring using AI-driven devices. LVET, Q2S2Max, and hemodynamic parameters were analyzed.

Hypothesis

ACG predict PE risk via LVET monitoring.

Results

Significantly prolonged LVET in the PE group (320.28 ± 26.79 ms vs. 301.32 ± 35.42 ms, p = 0.026), correlating with increased cardiac afterload. ROC analysis revealed moderate diagnostic efficacy for LVET alone (AUC = 0.658, sensitivity 72.4%, specificity 57.1%). Combining LVET with hypertension history enhanced performance (AUC = 0.776, specificity 77.8%), reducing false positives. Elevated Q2S2Max in PE (426.10 ± 29.46 vs. 403.96 ± 33.28, p = 0.010) indicated vascular stiffness, suggesting early vascular-cardiac coupling dysfunction.

Conclusions

ACG-derived parameters, integrated with clinical risk factors, demonstrated cost-effective, dynamic monitoring potential for early PE detection, particularly in resource-limited settings. While limited by sample size and single-center design, this study highlights ACG as a promising tool for cardiovascular risk stratification in pregnancy, warranting further validation in larger cohorts.

Background

Hyperlipidemia, a key risk factor for cardiovascular disease, is characterized by elevated low-density lipoprotein cholesterol (LDL-C), triglycerides, and reduced high-density lipoprotein cholesterol (HDL-C). Cholesteryl ester transfer protein (CETP) inhibitors, such as anacetrapib, obicetrapib, evacetrapib, dalcetrapib, and torcetrapib, aim to improve lipid profiles by increasing HDL-C and reducing LDL-C, but their comparative efficacy remains unclear.

Methods

This systematic review and frequentist network meta-analysis, conducted per PRISMA-NMA guidelines, included 33 randomized controlled trials (RCTs) involving 120,292 adults with hyperlipidemia. We compared CETP inhibitors, alone or with statins, against placebo or other lipid-lowering therapies. Primary outcome was LDL-C reduction; secondary outcomes included HDL-C, triglycerides, and total cholesterol changes. Random-effects models calculated mean differences (MD) with 95% confidence intervals (CI), and P-scores ranked interventions.

Results

Atorvastatin + obicetrapib showed the largest reduction in LDL-C levels (MD: −69.00, 95% CI: −95.96 to −42.04, p < 0.0001), followed by rosuvastatin + obicetrapib (MD: −60.70, 95% CI: −99.28 to −22.12, p = 0.0020). Atorvastatin + obicetrapib yielded highly significant increase in HDL-C levels (MD: 149.90, 95% CI: 121.70 to 178.10, p < 0.0001), but rosuvastatin + obicetrapib showed the greatest increase (MD: 158.90, 95% CI: 118.59 to 199.21, p < 0.0001) and obicetrapib monotherapy (MD: 139.00, 95% CI: 129.05 to 148.96, p < 0.0001), while rosuvastatin + evacetrapib led triglyceride reductions (MD: −31.70 mg/dL). Rosuvastatin was most effective for total cholesterol (MD: −31.60 mg/dL).

Conclusion

CETP inhibitors, particularly anacetrapib and obicetrapib combined with statins, significantly improve lipid profiles, offering potential therapeutic benefits for hyperlipidemia management and cardiovascular risk reduction.

Trial Registration: The study was registered with PROSPERO to ensure transparency and adherence to methodological rigor (Registration ID: CRD420250652666).